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INBDE

INBDE practice questions, INBDE practice test and dental board prep for the current exam

The INBDE is not a recall exam with a dental vocabulary. It is built around patient boxes: clinical scenarios that force you to apply foundation knowledge to a real case. That is why students who memorized their way through NBDE-era question banks are the ones who get surprised. Practice the integrated format.

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  • Built around the patient-scenario format the current exam actually uses
  • Every answer explained, so you build clinical reasoning rather than recall
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The short answer

The Integrated National Board Dental Examination (INBDE) is the single dental board exam US dental graduates must pass for licensure, replacing the old NBDE Part I and Part II. It is 500 multiple-choice items delivered over two days: Day 1 runs 8 hours 15 minutes with 360 items, and Day 2 runs 4 hours 15 minutes with 140 items, for 12 hours 30 minutes of total scheduled time. A scale score of 75 is the minimum passing score, and results are reported only as pass or fail. The fee is $890, and candidates must pass within five years or five attempts, whichever comes first. Aspirants.ai generates unlimited INBDE-style case-based questions, explains every answer, and costs from $9 a month.

Last updated August 2026

Work the questions

INBDE sample questions with answers and explanations

Eight INBDE style items written in the integrated, patient-box format the exam uses, where clinical, biomedical and behavioral content are tested together rather than as separate subjects. Read every rationale, including why the wrong answers are wrong.

Question 1 · Patient management

Four patients present for scaling and root planing with manipulation of gingival tissue. Which one requires antibiotic prophylaxis under current American Heart Association guidance?

  1. A. A patient with mitral valve prolapse and documented regurgitation
  2. B. A patient with a prosthetic heart valve
  3. C. A patient with a drug-eluting coronary stent placed 8 months ago
  4. D. A patient with a repaired atrial septal defect, fully healed 3 years ago with no residual defect
Show the answer and explanation

B. A patient with a prosthetic heart valve

The AHA narrowed prophylaxis sharply in 2007 and its 2021 scientific statement reaffirmed those recommendations without change. Coverage is limited to the categories at highest risk of an adverse outcome from infective endocarditis: prosthetic heart valves or prosthetic material used in valve repair, previous infective endocarditis, specific forms of congenital heart disease, and cardiac transplant recipients who develop valvulopathy. Option A is the single most common error, because mitral valve prolapse was covered under the pre-2007 guidance and many patients still believe they need premedication. Option C is also outdated thinking: coronary stents are not an indication, and the AHA has never recommended prophylaxis for them. Option D describes completely repaired congenital heart disease with no residual defect beyond six months, at which point prophylaxis is no longer indicated. Note the procedure itself qualifies here, since prophylaxis applies only to procedures involving manipulation of gingival tissue or the periapical region, or perforation of the oral mucosa.

Question 2 · Pharmacology calculation

A healthy 70 kg adult requires 2% lidocaine with 1:100,000 epinephrine, supplied in 1.8 mL cartridges. Using the maximum recommended dose of 7 mg/kg, what is the greatest number of whole cartridges that may be administered?

  1. A. 9 cartridges
  2. B. 11 cartridges
  3. C. 13 cartridges
  4. D. 16 cartridges
Show the answer and explanation

C. 13 cartridges

Work the units deliberately, because this is where the marks are lost rather than in the arithmetic. A 2% solution is 20 mg/mL by definition, so a 1.8 mL cartridge contains 36 mg of lidocaine. The patient's maximum is 7 mg/kg times 70 kg, which is 490 mg, and that sits below the 500 mg absolute ceiling for lidocaine with a vasoconstrictor, so 490 mg is the operative limit. Dividing 490 by 36 gives 13.6 cartridges, and because you cannot give a partial cartridge safely against a maximum you round down to 13. Option D comes from using the 500 mg cap with a rounded 30 mg per cartridge. The epinephrine concentration is a distractor here, though it has its own separate limit that becomes the binding constraint in patients with significant cardiovascular disease.

Question 3 · Periodontics

Under the 2017 World Workshop classification of periodontal diseases, what determines the STAGE assigned to a patient with periodontitis?

  1. A. The rate at which the disease has progressed over time
  2. B. The severity and complexity of management, based primarily on interdental clinical attachment loss
  3. C. The percentage of sites that bleed on probing
  4. D. The patient's smoking status and glycemic control
Show the answer and explanation

B. The severity and complexity of management, based primarily on interdental clinical attachment loss

The 2017 classification replaced the old chronic and aggressive categories with a two-axis system, and keeping the axes straight is the whole point of the question. Stage describes severity and the anticipated complexity of treatment, and it is assigned primarily on interdental clinical attachment loss at the worst-affected site, with radiographic bone loss and tooth loss due to periodontitis as further determinants. Grade is the second axis and describes the rate of progression along with the risk of further progression, which is what option A defines. Option D lists grade modifiers: smoking and diabetes shift the grade upward rather than the stage. Option C describes bleeding on probing, which is used to define the extent and to determine whether a case is stable, in remission or unstable, not to stage it. Note that clinical attachment loss rather than probing depth is the staging measurement, because recession would otherwise disguise real attachment loss.

Question 4 · Medical emergencies

Midway through an extraction, an anxious 24-year-old patient becomes pale and diaphoretic, reports feeling lightheaded, and then loses consciousness briefly. What is the most appropriate immediate management?

  1. A. Administer 0.3 mg epinephrine intramuscularly
  2. B. Place the patient supine with the legs slightly elevated and ensure a patent airway
  3. C. Give oral glucose as soon as possible
  4. D. Activate emergency medical services and begin chest compressions
Show the answer and explanation

B. Place the patient supine with the legs slightly elevated and ensure a patent airway

This is vasovagal syncope, the most common medical emergency in the dental office, and the presentation is textbook: a young anxious patient, a prodrome of pallor, sweating and lightheadedness, then a brief loss of consciousness. The mechanism is transient cerebral hypoperfusion, so the treatment is positional. Laying the patient flat with the legs slightly raised restores venous return and cerebral perfusion, and most patients recover within seconds. Option A treats anaphylaxis, which would present with urticaria, angioedema, bronchospasm or hypotension rather than a vagal prodrome. Option C treats hypoglycemia, plausible in a fasting diabetic patient but not indicated here, and giving anything by mouth to an unconscious patient risks aspiration. Option D escalates far too early: this patient has a pulse and is breathing, and compressions on a perfusing patient cause harm. If consciousness does not return promptly, then the diagnosis is wrong and escalation is appropriate.

Question 5 · Oral surgery

A patient on long-term warfarin needs a single routine extraction. The INR measured this morning is 2.4. What is the most appropriate approach?

  1. A. Stop warfarin for 3 days and reschedule
  2. B. Proceed with the extraction and use local hemostatic measures
  3. C. Refer to a hospital setting for the extraction
  4. D. Halve the warfarin dose for 48 hours before proceeding
Show the answer and explanation

B. Proceed with the extraction and use local hemostatic measures

Current guidance is to continue anticoagulation for routine dental extractions in patients whose INR is within the therapeutic range, generally taken as below 3.5, and to manage bleeding locally with sutures, oxidized cellulose or another hemostatic dressing, pressure, and tranexamic acid mouthwash where indicated. At an INR of 2.4 this patient is in range. The reasoning behind the recommendation is a risk comparison rather than a claim that bleeding will not occur: post-extraction bleeding is usually controllable at the chair, whereas interrupting anticoagulation exposes the patient to thromboembolic events including stroke, which are not. Options A and D both interrupt therapy and are the errors the guidance was written to prevent. Option C is unnecessary for a single routine extraction with an in-range INR, though a hospital setting becomes reasonable with a markedly elevated INR, extensive surgery, or significant comorbidity.

Question 6 · Pharmacology

A patient taking oral alendronate for 6 years for osteoporosis requires extraction of a non-restorable molar. Which statement best reflects the current understanding of risk?

  1. A. Extraction is contraindicated and the tooth should be left in place
  2. B. A drug holiday reliably eliminates the risk and must be completed first
  3. C. The risk of medication-related osteonecrosis of the jaw is low with oral bisphosphonates but rises with longer duration of therapy
  4. D. Risk with oral bisphosphonates is equivalent to that with intravenous antiresorptive therapy in oncology doses
Show the answer and explanation

C. The risk of medication-related osteonecrosis of the jaw is low with oral bisphosphonates but rises with longer duration of therapy

Absolute risk of MRONJ in patients on oral bisphosphonates for osteoporosis is low, far below the risk in patients receiving high-dose intravenous antiresorptives for malignancy, which makes option D wrong by a wide margin. Duration matters, and risk increases with cumulative exposure, which is why six years is worth noting in the history. Option A is the practical trap: leaving a non-restorable tooth in place is not the safe choice, because infection and the extraction that eventually becomes unavoidable are themselves major precipitants of osteonecrosis, so removing the tooth in a controlled way with informed consent is generally preferable. Option B overstates the evidence, since drug holidays are debated, bisphosphonates persist in bone for years, and no interruption reliably eliminates risk. The defensible plan is atraumatic technique, informed consent that names MRONJ specifically, and follow-up to confirm healing.

Question 7 · Radiographic interpretation

A periapical radiograph shows a well-defined radiolucency at the apex of a mandibular first molar. The tooth has a deep restoration, and the patient reports no symptoms. Pulp testing gives no response to cold or electric pulp testing. What is the most likely diagnosis?

  1. A. Periapical cyst or granuloma associated with pulpal necrosis
  2. B. Acute apical abscess
  3. C. Periapical cemento-osseous dysplasia
  4. D. Normal periapical anatomy, specifically the mental foramen
Show the answer and explanation

A. Periapical cyst or granuloma associated with pulpal necrosis

The pulp test result is the finding that decides this. No response to cold or electric pulp testing indicates a necrotic pulp, and a necrotic pulp with a well-defined apical radiolucency and no symptoms is asymptomatic apical periodontitis, which histologically is a granuloma or a radicular cyst. Radiographs cannot reliably distinguish those two, and the exam does not expect them to. Option B is excluded by the clinical picture, since an acute apical abscess presents with pain, swelling and often systemic signs, and typically shows little or no radiographic change early because bone loss takes time to become visible. Option C is a genuine mimic that appears at the apices of mandibular anterior teeth in its periapical form, but the defining feature is that the associated teeth are vital, which this tooth is not. Option D fails on position, since the mental foramen lies near the premolar apices rather than the first molar, and superimposition on a vital tooth would not explain the negative pulp test.

Question 8 · Prevention

A 4-year-old presents with two incipient enamel lesions and a diet high in sweetened drinks. What is the most appropriate professionally applied preventive intervention?

  1. A. 5% sodium fluoride varnish applied at least twice a year
  2. B. Immediate restoration of both lesions with composite
  3. C. A prescription for 0.2% sodium fluoride mouthrinse for daily home use
  4. D. Sealants placed on the anterior teeth
Show the answer and explanation

A. 5% sodium fluoride varnish applied at least twice a year

Incipient enamel lesions have not cavitated, so they remain capable of remineralizing, and the appropriate response is to arrest and reverse them rather than to cut tooth structure. Professionally applied 5% sodium fluoride varnish, which supplies 22,600 ppm fluoride, is the standard intervention for a high-risk child and is recommended at least twice yearly, alongside dietary counseling that addresses the sweetened drinks driving the problem. Option B treats a lesion that has not cavitated, removing sound enamel and committing a 4-year-old to a restoration cycle unnecessarily. Option C is inappropriate for the age, because fluoride mouthrinses are generally not recommended under age 6 given the swallowing risk, and this patient would be a poor candidate for a rinse in any case. Option D misplaces a valid intervention: sealants are indicated for pits and fissures of posterior teeth, not for smooth anterior surfaces.

These eight are a sample. Inside Aspirants.ai you can generate unlimited INBDE practice questions across the Clinical Content Areas and Foundation Knowledge, with the same depth of explanation on each answer choice.

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What the INBDE looks like: two days, 500 items

The INBDE is administered by the Joint Commission on National Dental Examinations, part of the ADA, and it replaced the two-part NBDE sequence. It runs across two days at a Prometric center. Day 1 has four sections: three sections of 100 standalone items at 105 minutes each, then a 60-item case section, also 105 minutes, for 8 hours 15 minutes total including optional breaks. Day 2 has two case-based sections of 70 items each, again 105 minutes apiece, for 4 hours 15 minutes. That is 500 items and 12 hours 30 minutes of scheduled time. The two days do not have to be consecutive, but they must fall within a 7-day period at the same test center, or you retest at your own expense.

  • Day 1: 360 items across four sections, 8 hours 15 minutes
  • Day 2: 140 case-based items across two sections, 4 hours 15 minutes
  • 500 items total, 12 hours 30 minutes of scheduled time
  • Both days must occur within 7 days at the same test center

What is actually tested: Clinical Content and Foundation Knowledge

The INBDE is built on the Domain of Dentistry, which contains 56 Clinical Content areas and 10 Foundation Knowledge areas. Clinical Content areas describe the tasks an entry-level general dentist performs, such as interpreting diagnostic results or evaluating a patient's condition. Foundation Knowledge areas describe the underlying science and reasoning needed to do those tasks. Every item ties the two together, which is what the word integrated in the exam title means: you are not asked to recall a fact from biochemistry in isolation, you are asked what that biochemistry implies for a specific patient in front of you. JCNDE publishes the exact percentage of items allocated to each section and Foundation Knowledge area in its test specifications.

  • 56 Clinical Content areas and 10 Foundation Knowledge areas
  • Every item integrates foundation science with a clinical task
  • Items are multiple choice with three to five response options
  • Only one option is the correct or best answer, no partial credit

How the INBDE is scored and the passing score of 75

The INBDE is criterion-referenced, meaning you are measured against a fixed standard rather than against other candidates, so there is no curve and no quota. A scale score of 75 is the minimum passing score. Scale scores are not raw scores, so 75 does not mean 75% correct: JCNDE converts raw performance onto a common scale so that a 75 means the same competency regardless of which form you drew. Results are reported only as pass or fail, and candidates who pass simply see "pass" with no number. Unsuccessful candidates receive remediation feedback at an overall level, for the three clinical content sections, and for each of the ten Foundation Knowledge areas. JCNDE targets releasing results within four weeks, and in most cases they arrive within three.

  • Criterion-referenced: no curve, no quota
  • Minimum passing scale score of 75, which is not 75% correct
  • Reported as pass or fail; passers receive no number
  • Results usually within three weeks, targeted within four

INBDE pass rates and difficulty

Graduates of CODA-accredited US dental programs pass at a very high rate. Per JCNDE annual reporting, first-attempt failure rates for CODA candidates have stayed under 5%, rising slightly to 4.8% in 2024 after a new performance standard raised the exam's rigor, which puts the first-time pass rate around 95%. Candidates from non-accredited programs, mostly internationally trained dentists, face a much harder path: their first-time failure rates ran from 33.1% in 2021 to 25.3% in 2024, so roughly a quarter to a third do not pass on the first try. If you trained outside a CODA program, plan for a longer preparation window and far more case-based question practice than a US graduate needs.

Cost, retakes and the Five Years / Five Attempts rule

The INBDE examination fee is $890, which covers results reporting to you, three licensing jurisdictions selected at application, and your CODA-accredited dental program. Candidates from non-CODA programs pay an additional $435 processing fee. JCNDE also offers a bundle of the INBDE and the DLOSCE for $1,080, a $470 saving over buying both separately. All fees are non-refundable. On retakes, you must wait a minimum of 60 days between unsuccessful attempts, and the Five Years / Five Attempts Eligibility Rule requires you to pass within five years of your first attempt or within five attempts, whichever comes first. Candidates who have already passed may not retake the exam unless a dental board requires it.

  • Examination fee $890; non-CODA candidates add $435
  • INBDE plus DLOSCE bundle: $1,080, saving $470
  • Minimum 60-day wait between unsuccessful attempts
  • Five Years / Five Attempts rule, whichever comes first

Compare the options

INBDE prep options compared

What each route costs and what it gets you. Providers discount often, so verify current pricing before you buy.

Option Typical US cost What you get Best for
Bootcamp.com (INBDE Booster) about $300 to $600 Large INBDE question bank, videos, study schedule The most widely used dedicated INBDE bank
DentalDecks about $200 to $400 Printed flashcard decks by subject Candidates who study from physical cards
Mental Dental free to about $100 Video lectures covering foundation science Filling content gaps before question practice
First Aid for the INBDE about $50 to $80 A single review text One reference to structure content review
Aspirants.ai from $9/mo Unlimited INBDE-style case-based questions, every answer explained Adding high-volume integrated practice to any resource above

The $890 JCNDE examination fee is separate from any prep resource. Competitor prices are approximate and change often. Verify current pricing with each provider before you buy.

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Honest answers

INBDE practice questions, answered straight.

The INBDE has 500 multiple-choice items delivered across two days. Day 1 covers 360 items in four sections (three sections of 100 standalone items plus a 60-item case section). Day 2 covers 140 case-based items in two sections of 70. Total scheduled time is 12 hours 30 minutes.

A scale score of 75 is the minimum passing score on the INBDE. Scale scores are not raw scores, so 75 does not mean answering 75% of items correctly. Results are reported only as pass or fail, and candidates who pass do not receive a numerical score at all.

For graduates of CODA-accredited US dental programs the INBDE is very passable: first-attempt failure rates have stayed under 5%, reaching 4.8% in 2024 after a stricter performance standard took effect. Candidates from non-accredited programs fail far more often, with first-time failure rates around 25% to 33%.

The Five Years / Five Attempts Eligibility Rule requires you to pass the INBDE within five years of your first attempt or within five attempts, whichever comes first. You must wait a minimum of 60 days between unsuccessful attempts. Candidates who have already passed may not retake it unless a dental board requires it.

The INBDE examination fee is $890, covering results reporting to you, three licensing jurisdictions and your dental program. Candidates from programs not accredited by CODA pay an extra $435 processing fee. A bundle including the DLOSCE costs $1,080, saving $470 over buying both separately.

US dental students commonly prepare for six to ten weeks alongside coursework, front-loading foundation science review and then shifting to case-based question practice. Internationally trained dentists typically need considerably longer, often three to six months, because the integrated patient-box format differs from most non-US board exams.

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